I am a physiotherapist. As a physiotherapist, I want to help people feel better. My clinical background is working with people with spinal pain (often chronic/persistent pain). As a young physio, my understanding about pain is a little. What I got in college not complex as I see in the clinical practice. I often fail. My old assumption is biomedical model that pain is always caused by structural anatomical biomechanical issue. And then I realize that I was wrong. I move on and change my mindset from biomedical to biopsychosocial model of care (really, it’s hard to change, but change is a must 😊)
What’s the difference between ‘biomedical’ vs ‘biopsychosocial’?
“The biopsychosocial model rejects the biomedical model because the biomedical model is not concerned with the person. But it does not reject the role of structural, biomechanical and functional disturbance of body tissue as potentially powerful drivers of protection”
Moseley & Butler, in press Explain Pain Supercharged
Today, I’ve found an article about pain personality and would be interesting to share
Here… “New evidence for a pain personality? A critical review of fhe last 120 years of pain and personality”
Background: Personality traits may influence development and adjustment to ongoing pain. Over thepast 120 years, there has been considerable research into the relationship between pain and personality.This paper presents new evidence for common personality traits found amongst chronic pain sufferers.In particular, it evaluates evidence for Cloninger’s biopsychosocial model of personality in distinguishingtypical personality features of chronic pain sufferers. It evaluates this evidence in the context of thepast 120 years of research including psychodynamic formulations, MMPI studies, personality disorderinvestigations, and the influence of neuroticism on chronic pain.
Conclusion: Recent descriptive studies using Cloninger’s Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic,sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifestsas difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy,musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of ‘a pain personality’. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support ‘a pain personality’ and may be confounded by somatic items in the instru-ment. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples.
A personality profile may be a factor in individuals developing a fear-avoidance response to pain, which contributes to the development and maintenance of chronic pain
Research suggests that anxiety related personality traits can be improved with cognitive-behavioral therapy (CBT), and CBT anxiety treatment protocols are suggested to be effective for chronic pain management.
Cognitive restructuring may help to address catastrophic thinking. Graded exposure and behavioral experiments for feared activities may help to address avoidance and fearful beliefs.
Assessing for higher HA and lower SD will enhance case formulation and may signal the need for broader and deeper treatment methods. For example, if a patient is sensitive to criticism or has a strong need for re-assurance, therapies such as schema therapy which focus on the quality of the therapist-client relationship and address attachment needs may engender a greater sense of self and security in the client, a reduced need for re-assurance and thus enhanced resilience.
Take home message:
1. Enhance the relationship with the person
2. Improve communication
Thanks,
Firman.
Movement Pain PT 